Gambar halaman

tal, in May, 1877, the symptoms were convulsive cough and fetid expectoration, containing large quantities of lung tissue, and so offensive in character as to cause frequent vomiting. There was also considerable pyrexia, the physical signs denoted consolidation of the base of the left lung, with commencing excavation. During his stay in the hospital the area over which caverous sounds were audible, increased considerably. Various kinds of treatment were tried to relieve the cough, and to facilitate and disinfect the expectoration, but all with only temporary benefit; and as the patient appeared to be poisoned more and more by the retained expectoration, and exhausted by the cough. On October 16th, 1877, a medium-sized aspirator needle was passed between the eighth and ninth ribs, in the area of the cavernous sounds, and appeared to reach the cavity, but on exhaustion only a few drops of blood followed the operation, and the puncture was subsequently closed with lint. The patient afterward suffered pain in the infra-mammary region, but as his symptoms continued to increase, a fortnight later a second attempt was made to reach the cavern; this time the intercostal space below the scene of the first operation being selected, and a trocar and a large drainage-tube were introduced. On reaching the pleura a pint of brownish, fetid fluid escaped, which proved under the microscope to consist of broken down pus cells. Symptoms of collapse followed the evacuation of the fluid, and the patient was with difficulty rallied with stimulants. The abscess was washed out with disinfectants, but no improvement took place, and the patient gradually sank, three days after the operation.

On post-mortem examination it was found that the lung contained a labyrinthine cavity formed by the breaking down of the walls of several dilated bronchi, one of which had been penetrated by the first operation. Overlying the cavity was a limited empyema, which the second operation had evacuated. The right lung was affected by recent pneumonia, the result of infection through inhaled secretion from the left, this being the immediate cause of death.-Medical and Surgical Reporter.

Iodoform as a Local Anæsthetic.-In a recent article in the Winer Med. Wochenschrift, Dr. Moleschott says he has often relieved or removed the most intense gouty pains and other symptoms of gouty inflammation within twentyfour hours, by painting on the collodion. In rheumatic pains it is efficacious, but in the various neuralgies, (intercostal, sciatic, etc.,) it succeeds excellently. Unfortunately, as most people know, iodoform has a disagreeable smell, which makes those using it objectionable to others. To obviate this Moleschott advises that the glass vessel containing the iodoform preparation (collodion, or, what he also uses, ointment) be kept outside the window, in a leaden box provided with a well-fitting cover, the opacity of the box having the additional advantage of retarding the decomposition of the iodoform by light. He also covers with gutta percha tissue the part anointed with the collodion ; and if possible, only applies the iodoform at night, so that most of it is absorbed, or has evaporated, before the morning, and what remains (if the ointment is used) can easily be removed with soap

and water. The use of iodoform sometimes causes cardiac palpitation, but Dr. Moleschott has also more than once found a weak, irregular pulse rendered stronger and more regular by small internal doses of iodoform, just as by small doses of digitalis.Medical and Surgical Reporter.

On Insolation and Refrigeration.-Dr. KIRCHNER has recently carried out a series of experiments on animals with a view to gain an insight into the pathogenesis of the two allied processes, insolation and refrigeration.

He deduces from them that the latter may be characterized as progtration of the vital forces, and, first of all, of respiration and circulation. The morphotic and chemical alteration of the blood resulting therefrom, particularly its impoverishment in oxygen, is the immediate cause of the derangements that directly threaten life. Warmth, on the other hand, acts as an irritant on animal organism, and when in excess leads to exhaustion. This constitutes the essence of insolation. As in the case of refrigeration, the foundation of the symptoms is the exhaustion of the oxygen of the blood, which here too is the consequence of the failing respiration and circulation. The appearance of rigidity during exposure, either to cold or heat, indicates excessive lack of oxygen in the blood. This rigidity is, like the rigor mortis, an anæmic muscular tetanus. If, however, we put coagulation, or, in other words, coagulation of the muscles, out of the question, tonic muscular rigidity is not commonly met with in cases of refrigeration or insolation.

The deleterious action of extreme temperatures on the organism is heightened by other weakening influences which tend to impair the supply of oxygen and to exhaust the resisting power of the system. Here must be mentioned, particularly, the misuse of alcohol. In addition to these acute effects of the action of cold and heat, there are analagous chronic conditions, which must be ascribed to the gradual action of extreme temperatures in the organism. They are characterized by manifestations of anæmia or exhaustion, and in their higher grades partly constitute the basis of the tropical and polar cachexias. It is still an open question whether any other specific diseases owe their origin to the influence of heat and cold. The fact that abdominal typhus occurs most frequently during the latter part of summer and towards the end of winter, has not yet been satisfactorily accounted for; and, as in many cases, no external source of infection can be discovered, it is, in fact possible that the morphotic and chemical alterations of the blood and tissues, which have been proved to be the pathological effects of insolation and refrigeration, play at least a subsidiary role in the production of the infection.-(Allg. Med. Cent. Zeit., No. 47, 1878).Medical Record, N. Y.

The Surgical Treatment of Lupus.-In an article by M. Hillariet, quoted in the London Medical Record, the writer says:

It was Veiel who first introduced acupuncture. The method consists in pricking the surface of the lupus with needles, either in bundles, or fixed in the same handle, but separated from one another by some millimeters. The needles, before being used, should be heated to a red colour. This plan, is however, at the present time much less employed than the scraper and linear scarification. Volkmann invented the scraper, and published his proceeding in 1870. It consists in scratching the surface of the lupus with curettes of different shapes, but generally of small dimensions. It is necessary, in order to aid the action of the instrument, to raise up all the lupoid tissue, and one may be satisfied with the result when the curette comes upon .more resisting parts ; this is healthy tissue; the operator should then stop. It is generally necessary to repeat the operation one or more times a month until the healing of the lupus is complete. Volkmann and Hebra both advise cauterization of the scraped surface with nitrate of silver. This method of Volkmann's gives very good results, but it is not applicable to all cases of lupus, and I more often employ linear scarification. To practice this, a needle, slightly flattened, with sharp edges may be used. Or, following the example of Balmanno Squire, a scarificator with numerous blades, which he has expressly constructed, may

be used. Personally, I find the needles most easy to manage, and I make the linear incisions separated by a few millimetres. I place my incision in such a way that some are perpendicular to the others, and I repeat the operation one or more times a month until the lupus is well. I have obtained by this practice very good results, and I believe that this method is destined to be of great service. It offers one inconvenience, that is, it gives rise to hemor rhage, which may be very abundant, and in patients with frail constitutions this may be injurious. I should say a great deal of this loss of blood may be avoided by applying to the lupoid surfaces, before operating, some convenient anæsthetic and afterward by the immediate use of perchloride of iron ; this may be simply done by means of a piece of blotting paper, as recommended by Balmanno Squire. Another recommendation of linear scarification is, that it can be more easily and more promptly repeated than cauterization.—Med. f Surg. Reporter, Copaiba in Cirrhosis and Jaundice.—The value of copaiba as a diuretic, and cholagogue is not sufficiently appreciated. The following case, reported in the British Med. Journal, by Dr. J. B. Massiah, illustrates it :

W. D., aged 37, a clerk, was a spirit drinker för four years, seven years ago ; and during the last four years and a half has had three prolonged and painful attacks of jaundice, with ascites and oedema of the lower limbs. On admission, three months ago, he was tawny, thin and rather weak. He complained of constant pain in the umbilical and lumbar regions. His fluctuating abdomen measured thirty-four inches in circumference, and the vertical hepatic dullness in the nipple-line was three inches. The urine was scanty, bilious, and exalbuminous.

During the first month he took bitartrate of potash and compound jalap powder; and the abdomen increased two inches, the urine remaining scanty. Then, under a scruple of copaiba thrice daily, rose on successive days, from one pint in twentyfour hours to three, four and five pints ; while the ascites began to subside. Once, for a fortnight, he took half a drachm of tincture of belladonna thrice daily, for the abdominal pain, and the quantity of urine fell below two pints daily. The abdomen now measures thirty-three inches in circumference, and his general health is much improved.-Med. f Surgical Reporter.

Necrosis without Suppuration.-William Colles, M. D., in the Dublin Journal of Medical Sciences for December, 1878, reports the following case :

“F., aged 15, healthy, was thrown from a carriage and received some bruises on the face ; also there was a slight transverse wound, about one fourth of an inch, at the ulnar side of the left wrist close to the joint. Through this opening projected a small piece of very rough bone, which was considered to be the lower end of the ulna broken off and projecting. It could not be restored or retained in position. Two days later she was put under the influence of chloroform, but it was still found impossible to restore the natural form of the limb. It was therefore determined to remove the projecting piece.

« SebelumnyaLanjutkan »